Healthcare Provider Details

I. General information

NPI: 1598983827
Provider Name (Legal Business Name): MICHAEL MCCUBBIN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 WASHINGTON ST
PELLA IA
50219-1508
US

IV. Provider business mailing address

1108 WASHINGTON ST
PELLA IA
50219-1508
US

V. Phone/Fax

Practice location:
  • Phone: 641-621-1487
  • Fax: 641-621-1601
Mailing address:
  • Phone: 641-621-1487
  • Fax: 641-621-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number21379
License Number StateIA

VIII. Authorized Official

Name: MICHAEL M MCCUBBIN
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 641-621-1487